Professional Documents
Culture Documents
Instructions For UPSC Exams
Instructions For UPSC Exams
NO
REQUEST FOR WITHDRAWAL OF CANDIDATURE RECEIVED FROM A
CANDIDATE AFTER HE / SHE HAS SUBMITTED HIS/HER APPLICATION WILL BE ENTERTAINED.
5. FEE
A candidate seeking admission to examination must pay to the Commission a fee of Rs. 200.00
(Rupees Two Hundred only) through Central Recruitment Fee Stamps. Central Recruitment Fee
Stamps (NOT postage stamps) may be obtained from the post office and affixed on the
application form in the space provided therein. The stamps may be got cancelled from the issuing
Post Office with the date stamp of the Post Office in such a manner that the impression of the
cancellation mark partially overflows on the application form itself. The impression of the
cancellation mark should be clear and distinct to facilitate the identification of date and the Post
Office of issue.
Candidates residing abroad should deposit the prescribed fee in the office of India's High
Commissioner, Ambassador or Representative abroad as the case may be for credit to account
head "051-Public Service Commission-Examination Fees" and attach the receipt with the
application.
FEMALE CANDIDATES AND CANDIDATES BELONGING TO SCHEDULED CASTES/
SCHEDULED TRIBES ARE NOT REQUIRED TO PAY ANY FEE. NO FEE EXEMPTION IS,
HOWEVER, AVAILABLE TO OBC CANDIDATES AND THEY ARE REQUIRED TO PAY THE FULL
PRESCRIBED FEE.
Physically disabled persons are exempted from the payment of fee provided they are
otherwise eligible for appointment to the Service/posts to be filled on the results of this
examination on the basis of the standards of medical fitness for these Services/posts (including
any concessions specifically extended to the physically disabled). A physically disabled candidate
claiming fee concession must submit along with his/her Detailed Application Form and a certified
copy of the certificate from a Medical Board in support of his/her claim for being physically disabled
duly indicating the percentage of disability. [Refer para 22].
Note.Notwithstanding the aforesaid provision for fee exemption, a physically disabled
candidate will be considered to be eligible for appointment only if he (after such physical
examination as the Government or the appointing authority, as the case may be, may prescribe)
is found to satisfy the requirements of physical and medical standards for the concerned
Services/posts to be allocated to physically disabled candidates by the Government.
Postage Stamps will in no case be accepted in lieu of Central Recruitment Fee Stamps.
Candidates should note that the fee sent through Indian Postal Orders, Bank Draft, Money
Order, Crossed Cheque, Currency Notes or Treasury Challan etc. will not be accepted by the
Commission and such applications will be treated as without fee and will be summarily rejected.
NOTE I : Applications not accompanied by the prescribed fee (unless remission of fee is
claimed) shall be summarily rejected.
NOTE II: Fee once paid shall not be refunded under any circumstances nor can the fee be
held in reserve for any other examination or selection.
6.
Candidates are advised to read carefully the Rules of the Examination which include the
detailed scheme of the examination, as published in the Govt. of India Gazette (Extraordinary)
dated 3 1 s t M ay , 20 1 4 (copy can be downloaded from UPSC website). They should note that no
correspondence will be entertained by the Commission from candidates to change any of the
entries made in the application form. They should, therefore, take special care to fill up the
application form correctly. No column of the application form should be left blank.
Candidates should note that under no circumstances will they be allowed to change in Centre,
Optional Subject, Indian Language paper (Paper-A) and Medium of Examination they have
indicated in their filled online CS(P) application form.
If any candidate appears,
(i) at a centre other than the one indicated by the Commission in his e.Admit Card; or
(ii) in an optional subject other than the one indicated by the Commission in his e..Admit Card; or
(iii) in an Indian language paper other than the one indicated by the Commission in his
e..Admit Card.
papers of such a candidate will not be valued, and the candidature will be liable to
cancellation.
7.
The receipt of the hard copy/printout of the final DAF shall be acknowledged
electronically by sending email by the Commission. Online application or which is incomplete
or is incorrectly filled in or gives wrong code numbers in any of the columns is liable to be rejected.
8.
Every candidate for this examination will be informed at the earliest possible regarding
date of the receipt of his/her application. If, however, a candidate does not receive from the
Union Public Service Commission a communication confirming receipt of his/her application
two weeks before the commence of the examination, he/she should at once contact the
Commission, web-upsc@nic.in or 011-23385271. Failure to comply with this provision will
deprive the candidate of any claim to consideration.
Candidates admitted to the examination will be given e-Admit Card which they will have
to download from the Commissions website and which will permit them to take the
examination. On obtaining the e-Admit Card, a candidate should check it carefully to ensure
that the particular printed on the e-Admit Card are correct. In case, there is any mistake in
the e-Admit Card should be brought to the Commission with a request to issue the correct eAdmit Card. Candidates may note that they will not be allowed to take the examination on
the strength of e-Admit Card issued in respect of another candidate.
9.
Candidates are required to specify clearly in Col. 21 of the Application Form their order
of preference for various Services/posts for which they would like to be considered for
appointment in case they are recommended for appointment by the Commission.
For example, if Indian Administrative Service is his first preference he should write
against Indian Administrative Service. Similarly, if Indian Police Service is his/her
third preference, he should write against 0 3
Indian Police Service.
0
12.
The Roll No. of the candidate for the Main Examination will be the same as the Roll
Number given to him/ her for the Preliminary Examination.
13.
Attention is invited to Notes I and IV under Rule 7 of the Rules for the Civil Services
Examination 2014. All candidates who are declared qualified by the Commission for taking the Civil
Services (Main) Examination should produce the proof of passing the requisite qualifying
Examination alongwith their application for the Main Examination failing which such candidates
will not be admitted to the Main Examination and their candidature will be cancelled.
Note :Candidates who have passed the final professional MBBS or any other Medical
Examination but have not completed their internship by the time of submission of their applications
for the Civil Services (Main) Examination, will be provisionally admitted to the Examination provided
they submit alongwith their application a copy of the certificate from the concerned authority of the
University/lnstitution that they had passed the requisite final professional medical Examination.
In such cases the candidates will be required to produce at the time of their interview original
Degree or a certificate from the concerned competent authority of the University/ Institution
that they had completed all requirements (including completion of internship) for the award of the
Degree.
14.
Persons in Government service whether in a permanent or temporary capacity or as
work charged employees other than casual or daily rated employees or those serving under Public
Enterprises are required to submit an undertaking (as in the Declaration printed in the Application
Form) that they have informed in writing their Head of Office/ Department that they have applied for
the Examination.
15.
Candidates should note that in case a communication is received from their employer
by the Commission withholding permission to the candidates applying for/ appearing at
the Examination, their applications will be liable to be rejected/candidature will be liable
to be cancelled.
16.
A candidate appearing in the examination should also bring with him/ her to the
examination hall extra copies of the photograph similar to the one affixed on the
application form. Photocopies of the photographs are not acceptable.
17.
A candidate who claims to belong to one of the Scheduled Castes/Scheduled Tribes or
the Other Backward Classes (OBCs) should submit in support of his/her claim an
Attested/certified copy of a certificate in the form given below from the District Officer or the SubDivisional Officer or any other Officer as indicated below, of the district in which his/ her parents
(or surviving parent) ordinarily reside, who has been designated by the State Government
concerned as competent to issue such a certificate. If both his/her parents are dead, the officer
signing the certificate should be of the district in which candidate himself/herself ordinarily
resides otherwise than for the purpose of his/her own education.
(A) The form of certificate to be produced by Scheduled Castes/Scheduled Tribes
candidates applying for appointment to posts under the Government of India.
'This is to certify that Shri/Shrimati/Kumari* ................................son/daughter* of.
....................of village/town * ..................................................in District/Division * .................of the
State/Union Territory *................................................................ belongs to the caste/tribe*
which is recognized as Scheduled Caste/Scheduled Tribe* under:
the Constitution (Scheduled Castes) Order, 1950@.
the Constitution (Scheduled Tribes) Order, 1950@.
the Constitution (Scheduled Castes) (Union Territories) Order, 1951@.
the Constitution (Scheduled Tribes) (Union Territories) Order, 1951@.
[as amended by the Scheduled Castes and Scheduled Tribes List (Modification) Order, 1956; the
Bombay Reorganization Act, 1960; the Punjab Reorganization Act, 1966; the State of Himachal
Pradesh Act, 1970; and the North Eastern Areas (Reorganization) Act, 1971 and the Scheduled
Castes and Scheduled Tribes Orders (Amendment) Act, 1976, the State of Mizoram Act, 1986 the
State of Arunachal Pradesh Act, 1986 and the Goa, Daman and Diu (Reorganization) Act, 1987.]
the Constitution (Jammu and Kashmir) Scheduled Caste Order, 1956(@.
the Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959 as amended by the
Scheduled Castes and Scheduled Tribes Order (Amendment) Act, 1976. @
the Constitution (Dadra and Nagar Haveli) Scheduled Castes Order,1962.@
the Constitution (Dadra and Nagar Haveli) Scheduled Tribes Order,1962.@
the Constitution (Pondicherry) Scheduled Castes Order, 1964.@
the Constitution (Uttar Pradesh) Scheduled Tribe s Order, 1967.@
the Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968.@
the Constitution (Goa, Daman and Diu) Scheduled Tribes Order, l968.@ .
the
Note 2: Creamy layer clause in respect of OBC candidates must be as per OM No. 36033/1/2013Estt (Res) dated 27/05/2013.
*Please delete the words which are not applicable.
Note: The term ordinarily reside( s) used here will have the same meaning as in Section 20
of the Representation of the People Act, 1950.
**List of Authorities empowered to issue Other Backward Classes certificate will be the same as
those empowered to issue Scheduled Caste/Scheduled Tribe certificates.
@Strike out whichever is not applicable.
Note l : Candidates claiming to belong to OBCs should note that the name of their caste
(including its spellings) as indicated in their certificates, should be exactly the same as
published in the lists notified by the Central Government from time to time. A certificate
containing any variation in the caste name will not be accepted.
Note 2 : The OBC claim of a candidate will be determined in relation to the State (or part of the
State) to which his father originally belongs. A candidate who has migrated from one State (or
part of the State) to another should, therefore, produce an OBC certificate which should have been
issued to him based on his father's OBC certificate from the State to which he (father) originally
belongs.
Note 3 : No change in the community status indicated by a candidate in his/her application
form for the Civil Services (Preliminary) Examination will ordinarily be allowed by the Commission.
18.
A candidate must submit along with this form an attested/certified copy of a certificate
showing that he has one of the qualification prescribed in Rule 7. The certificate submitted must
be one issued by the authority (i.e. University or othe r examining body) awarding the
particular qualification.
19. A candidate must enclose with his/her application an attested/certified copy of certificate of
age (indicating his date of birth).
The date of birth accepted by the Commission is that entered in the Matriculation or
Secondary School Leaving Certificate or in a certificate recognized by an Indian University as
equivalent to Matriculation or in an extract from a Register of Matriculates maintained by a
University which extract must be certified by the proper authority of the University. A candidate
who has passed the Higher Secondary Examination or an equivalent Examination may submit, an
attested/certified copy of the Higher Secondary Examination certificate or an equivalent
certificate.
No other document relating to age, like horoscopes, affidavits, birth extracts from Municipal
Corporation, Service Records and the like, will be accepted.
The expression Matriculation/Higher Secondary Examination certificate in this part of
the instruction includes the alternative certificates mentioned above.
Sometimes the Matriculation/Higher Secondary Examination Certificate does not show
the date of birth or only shows the age by completed years or completed years and months. In
such cases a candidate must send in addition to the attested/certified copy of the
Matriculation/Higher Secondary Examination certificate an attested/certified copy of the
certificate from the Headmaster/Principal of the Institution from where he passed the
Matriculation/Higher Secondary Examination showing date of his birth or his exact age as
recorde d in the Admission Register of the Institution.
Candidates are warned that unless complete proof of age as laid down in these
instructions is sent with an application, the application will be rejected.
Note l : A candidate who holds a completed secondary school certificate need submit only an
attested/certified copy of the page containing entries relating to age.
Note 2 : Candidates should note that only the date of birth as recorded in the
Matriculation/Higher Secondary examination certificate or an equivalent certificate on the
date of submission of Application will be accepted by the Commission and no subsequent
request for its change will be considered or granted.
Note 3 : Candidates should also note that once a date of birth has been claimed by them and
entered in the records of the Commission for the purpose of admission to an examination,
no change will be allowed subsequently or at a subsequent examination on any ground
whatsoever.
Candidates are required to submit alongwith their applications only copies of certificates
mentioned in Paragraphs 18 and 19 above, attested by a Gazetted Officer of the Government or
certified by candidates themselves as correct. Candidates qualified for interview for the
Personality Test on the results of the written part of the Main Examination will be required
to submit the originals of the certificates mentioned above. Failure to submit the required
certificates in original at that time will entail cancellation of candidature.
20 (i) A candidate claiming age-relaxation as a domicile of the State of Jammu and Kashmir should
produce an attested/ certified copy of a certificate from the District Magistrate in the State of
Jammu and Kashmir within whose jurisdiction he had ordinarily resided or from any other
authority designated in that behalf by the Government of Jammu and Kashmir to
the effect that he had ordinarily been domiciled in the State of Jammu and Kashmir during the
period from the 1st January, 1980 to the 31st day of December, 1989.
(ii) A candidate disabled while in the Defence Services claiming age concession should produce an
attested/certified copy of the certificate in the form prescribed below from the Director General
Resettlement, Ministry of Defence to show that he was disabled while in the Defence Services in
operations during hostilities with any foreign country or in a disturbed area and released as a
consequence thereof.
THE FORM OF CERTIFICATE TO BE PRODUCED BYTHECANDIDATE:
Certified that rank No._________Shri_________________________
of Unit was disabled while in
the Defence Services in operations during hostilities with a Foreign Country/in a disturbed area*
and was released as a result of such disability.
Signature...
Designation
Date.
*Strike out whichever is not applicable.
(iii) Ex -servicemen including Commissioned Officers and ECOs/SSCOs claiming age concession
in terms of Rule 6(b)( v) or 6(b)( vi) of the Rules for the Examination should produce an
attested/certified copy of the certificate as applicable to them, in the form prescribed below,
from the authority concerned.
(A) FORM OF CERTIFICATE APPLICABLE FOR RELEASED/RETIRED PERSONNEL.
It is certified that No._________Rank________ Name______________whose date of birth
is__________ has rendered service from __________to __________in Army/Navy/Air Force and he
fulfils ONE of the following conditions :
(a) Has rendered five or more years military service and has been released on completion of
assignment otherwise than (i) by way of dismissal or discharge on account of misconduct or
inefficiency; or (ii)* on his own request.
(b) Has been released on account of physical disability attributable to military service or on
invalidment on
Candidates furnishing certificate (B) as above will have to give the following undertaking:
UNDERTAKING TO BE GIVEN BYTHE CANDIDATE
I understand that if selected on the basis of the recruitment/Examination to which this
application relates, my appointment will be subject to my producing documentary evidence to the
satisfaction of the appointing authority that I have been duly released/retired/discharged from
the Armed Forces and that I am entitled to the benefits admissible to Ex-servicemen in terms of
the Ex-servicemen (Re-employment in Central Civil Services and Posts) Rules, 1979, as amended
from time to time.
Place :
Date:
Signature of Candidate
(C) FORM OF CERTIFICATE APPLICABLE FOR SERVING ECOs/SSCOs WHO HAVE ALREADY
COMPLETED THEIR INITIALASSIGNMENT AND ARE ON EXTENDED ASSIGNMENT.
It is certified that No.________Rank__________ Name
is serving in the Army/Navy/Air Force from
2.
He has already completed his initial assignment of five years on
assignment till _____________
and
is
on
extended
3. There is no objection to his applying for civil employment and he will be released on
three months notice on selection from the date of receipt of offer of appointment.
Station:
Name and Designation of the
Competent Authority
Date:
SEAL
Authorities who are competent to issue certificates are as follows :
(a) In the case of Commissioned Officers including ECOs/SSCOs. ArmyMilitary Secretarys
Branch, Army Hqrs., New Delhi.
NavyDirectorate of Personnel, Naval Hqrs., New Delhi.
Air ForceDirectorate of Personnel (Officers), Air Hqrs., New Delhi.
(b) In case of JCO/ORs and equivalent of the Navy and Air Force.
ArmyBy various Regimental Record Offices. NavyCABS, Bombay.
Air ForceAir Force Records NERW, New Delhi.
10
21. Candidates who hail from Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland or
Sikkim will be required to submit a certificate to that effect from the same authorities as are
empowered, to issue certificates in regard to SC/ST/OBC candidates (see para 17 above). These
certificates will have to be issued by the competent authorities of the above States only.
The form of the certificate will be as under:
This is to certify that Shri/Shrimati/Kumari* ............... son/daughter* of Shri................
Village/Town*............. in District/Division * .............................................hails from* * Arunachal
Pradesh/Manipur/Meghalaya/Mizoram/Nagaland/ Sikkim.
Date....................
Signature..............................
Place...................
Designation.........................
(Seal of Office)
11
26. (i) Candidates should note that data of Col (2), 3(a), 3(c), 3(e), 4, 5, 8(a), 10(a), 10(c), (11), 12 (i)(a),
12 (i)(b), 12(ii). 13(a). 13(c), 14.1, 15(a), 15(b) & 24 are pre-populated and have been taken from the
data filled up by the candidates at the time of filling up of on-line application form for Civil
Services(Preliminary) Examination -2014 and no change is permitted in any of these columns in the
Detailed Application Form.
(ii) In respect of Sindhi language they have to clearly indicate in words whether they will write
Sindhi in Devanagari script or Arabic script. Similarly for Santhali
language candidates
should clearly indicate whether they will write Santhali in Devanagari or Olchiki script. Candidates
may also note that the question papers of Santhali language will be printed in Devanagari script
only.
27. Candidates are required to indicate in Col.13(b) of the application form about the language
medium in which they would like to be interviewed at the time of Interview for Personality Test as
below:(a) The candidates, opting for Indian Language medium for the written part of the Civil
Services (Main) Examination, may choose either the same Indian Language or English or Hindi as
the medium for the interview.
(b) The candidates, opting to write the Civil Services (Main) Examination in English, may choose
as the medium for interview either English, or Hindi, or any other Indian Language opted by them
for the compulsory Indian Language Paper in the written part of the Civil Services (Main) Examination.
However, the candidates, who are exempted from the compulsory Indian Language Paper, will have
to choose either English or Hindi as medium of Interview for Personality Test.
28. Candidates should note that instead of separate Question Paper and answer book, a
consolidated Question Paper-cum-Answer book, having space below each part/sub part of a
question shall be provided to them for writing the answers. Candidates shall be required to
attempt answer to the part/sub-part of a question strictly within the pre-defined space. Any
attempt outside the pre-defined space shall not be evaluated.
29. Candidates should note that in no circumstances will they be allowed a change in the
script or language medium of the Examination for Essay, General Studies and Optional subject
or language medium for Interview for Personality Test which they have indicated in their
Application Form for the Main Examination.
30. Candidates should note that evaluation of the papers, namely, Essay, General Studies and
Optional Subject of all the candidates would be done simultaneously along with evaluation of
their qualifying papers on 'Indian Languages' and 'English' but the papers on Essay, General
Studies and Optional Subject of only such candidates will be taken cognizance who attain 30%
marks in Indian Language and 25% marks in English as minimum qualifying standards in these
qualifying papers.
31. In all communications with the Commission regarding his/her application the candidate should
mention the name of the Examination, his/her Roll Number, Name and his/her Date of birth.
A candidate must see that communications sent to him at the address stated in his
application are redirected, if necessary. Change in address should be communicated to the
Commission at the earliest opportunity. Although the Commission make every effort to take
account of such changes, they cannot accept any responsibility in the matter.
32. The Candidates should note that their candidature at all the stages of the Civil Services (Main)
Examination will be purely provisional, subject to their satisfying the prescribed eligibility
conditions. If on verification at any stage before or after the Main (Written) examination and Interview
Test, it is found that they do not fulfill any of the eligibility conditions; their candidature for the
examination will be cancelled by the Commission.
12
33.
Candidates are advised to paste a hard copy of their photograph on the first page of the
print out of the Detailed Application Form in the space provided for it. Candidates are also
advised to ensure that all the copies of photographs affixed by them on the application form are
identical. If, on verification at any stage any variation is found in the copies of Photographs
uploaded by a candidate on the application form for the Preliminary Examination and the
photograph pasted by the candidate on the hard copy of the Detailed Application Form of Main
Examination, his/her candidature will be liable to be cancelled by the Commission.
34. Candidates should also ensure that the signatures appended by them in all the places, viz. in
their application form, on the attendance list in the examination hall and in all and there should
be no variation of any kind. If any variation is found in the signatures appended by a candidate at
different places, his candidature will liable to be cancelled by the Commission.
35.
Enclosures to the application form to be sent to the Commission by the candidate are as
follows:
(1)
NOTE II:One hard copy of photograph and the Central Rectt. Fee stamps should be pasted
on the first page of the print out copy of the Application Form in the space provided for the purpose.
NOTE III:The application and the enclosures thereto should be arranged in the following
order:
13
14
19.
20.
21.
22.
23.
24.
25.
26.
Physics
Political Science & International Relations
Psychology
Public Administration
Sociology
Statistics
Zoology
Literature of any one of the following languages
(i). Assamese
(ii) Bengali
(iii) Bodo
(iv) Dogri
(v) English
(vi). Gujarati
(vii) Hindi
(viii) Kannada
(ix) Kashmiri
(x) Konkani
(xi) Maithili
(xii) Malayalam
(xiii) Manipuri
(xiv) Marathi
(xv) Nepali
(xvi) Oriya
(xvii) Punjabi
(xviii) Sanskrit
(xix) Santhali
(xx) Sindhi (Devanagari Script)
(xxi) Sindhi (Arabic Script)
(xxii) Tamil
(xxiii) Telugu
(xxiv) Urdu
Note (1) :
Only o n e optional subject is to be selected from the above list for Papers VI
and VII (as given in the Plan of Main Examination).
Note (2) : Candidates will have the option to answer all the question papers, except the qualifying
language papers, viz. Papers A and B in anyone of the languages included in the Eighth Schedule to
the Constitution or in English.
IV. Column 13(a) of the Application Form - MEDIUM OF EXAMINATION
Language
Assamese
Bengali
Bodo
Dogri
English
Gujarati
Hindi
Kannada
Kashmiri
Konkani
Maithili
Malayalam
Manipuri
Marathi
Nepali
Oriya
Script
Assamese.
Bengali.
Devanagari.
Devanagari.
English.
Gujarati.
Devanagari.
Kannada.
Persian.
Devanagari.
Devanagari.
Malayalam.
Bengali.
Devanagari.
Devanagari.
Oriya.
15
Punjabi
Sanskrit
Santhali
Sindhi
Tamil
Telugu
Urdu
Gurmukhi.
Devanagari.
Devanagari or olchiki.
Devanagari or Arabic
Tamil.
Telugu.
Persian.
Description
1
2
-a citizen of India.
-a subject of Nepal.
-a subject of Bhutan.
4
-a Tibetan refugee who came over to India before the
1st January, 1962, with the intention of permanently settling in India.
5
-a person of Indian origin who has migrated from Pakistan, Burma, Sri Lanka, East
African countries of Kenya, Uganda, the United Republic of Tanzania, Zambia, Malawi, Zaire and
Ethiopia and Vietnam with the intention of permanently settling in India.
VI. FORMAT OF UNDERTAKING TO BE FURNISHED BY OBC CANDIDATES.
UNDERTAKING
I,.son/daughter of Shri. Resident of
village/town/
city
district....
state.hereby declare that I belong to the..community which is
recognized as a backward class by the Government of India for the purpose of reservation in
services as per orders contained in Department of Personnel and Training Office Memorandum
No. 36012/22/93-Estt.(SCT),dated 8.9.1993. It is also declared that I do not belong to
persons/sections (Creamy layer) mentioned in Column 3 of the Schedule to the above referred
Office Memorandum, dated 8.9.1993, O.M. No. 36033/3/2004-Estt.(Res), dated 9.3.2004,
8.9.1993 O.M. No. 36033/3/2004-Estt.(Res), dated 14.10.2008 and O.M. No. 36033/1/2013Estt.(Res) dated 27/05/2013.
16
Form-I
APPLICATION FOR OBTAINING DISABILITY CERTIFICATE BY PERSONS WITH DISABILITIES
(See Rule 3)
.. .
(First name)
(Middle name)
1.
Name .
(Surname)
2.
3.
Date of Birth
4.
5.
Sex
6.
Address :
(a)
Permanent address
.. //.
Date
Month
Year
Male / Female
(b)
.....
.........
...
...
(c)
7.
Post Graduate
Graduate
Diploma
Higher Secondary
High School
Middle
Primary
Illiterate
8.
Occupation
9.
10.
11.
12.
(i) Did you ever apply for issue of a disability certificate in the past .
YES/NO
Have you ever been issued a disability certificate in the past? If yes, please
enclose a true copy.
Continued..
17
Declaration : I hereby declare that all particulars stated above are true to the best of my knowledge and
belief, and no material information has been concealed or misstated. I further state that if any
inaccuracy is detected in the application, I shall be liable to forfeiture of any benefits derived
and other action as per law.
Encl :
1.
Date:
Place:
18
Form - II
DISABILITY CERTIFICATE
(In cases of amputation or complete permanent paralysis of limbs and in cases of blindness)
(See Rule 4)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)
Recent PP size
Attested Photograph
(Showing face only) of
the person with
disability
Certificate No.
Date :
Locomotor disability
Blindness
(C)
The applicant has submitted the following document as proof of residence:Nature of Document
Date of Issue
Signature/Thumb
impression of the (Signature and Seal of authorized Signatory of notified Medical Authority)
person in whose
favour disability
certificate is
issued.
19
Annexure-VII
Form - III
DISABILITY CERTIFICATE
(In case of multiple disabilities)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)
(See Rule 4)
Recent PP size
Attested Photograph
(Showing face only) of
the person with
disability
Certificate No.
Date :
Disability
Affected Part of
Body
1.
Locomotor disability
2.
Low vision
3.
Blindness
Both Eyes
4.
Hearing Impairment
5.
Mental retardation
6.
Mental-illness
Diagnosis
Permanent physical
impairment/mental
disability (in %)
(B)
In the light of the above, his/her over all permanent physical impairment as per guidelines(to
be specified), is as follows:In figures :- ______________ percent
In words :- ___________________________________________________ percent
Continued .
20
2.
3.
Reassessment of disability is :
(i) not necessary,
Or
(ii) is recommended/after ________ years __________ months, and therefore this certificate
shall be
Valid till _______________
(DD)
4.
_________________ ________________
(MM)
(YY)
Left/Right/both ears
The applicant has submitted the following document as proof of residence:Nature of Document
5.
Date of Issue
Chairperson
Signature/Thumb
impression of the
person in whose
favour disability
certificate is
issued.
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Form - IV
DISABILITY CERTIFICATE
(In cases other than those mentioned in Forms II & III)
(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)
(See Rule 4)
Recent PP size
Attested Photograph
(Showing face only)
of the person with
disability
Certificate No.
Date :
Disability
Affected Part of
Body
1.
Locomotor disability
2.
Low vision
3.
Blindness
Both Eyes
4.
Hearing Impairment
5.
Mental retardation
6.
Mental-illness
Diagnosis
Permanent physical
impairment/mental
disability (in %)
Continued
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3.
Reassessment of disability is :
(i) not necessary,
Or
(ii) is recommended/after ________ years __________ months, and therefore this certificate
shall be
Valid till _______________
(DD)
4.
_________________ ________________
(MM)
(YY)
Left/Right/both ears
The applicant has submitted the following document as proof of residence:Nature of Document
Date of Issue
Countersigned
Note : In case this certificate is issued by a medical authority who is not a government servant, it shall be
valid only if countersigned by the Chief Medical Officer of the District.
Note : The principal rules were published in the Gazette of India vide notification number S.O. 908(E), dated
st
31 December, 1996.
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